Cited by 229Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

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Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review

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Borre, Ethan, Goode, Adam, Raitz, Giselle, Shah, Bimal, Lowenstern, Angela, Chatterjee, Ranee, Sharan, Lauren, Allen LaPointe, Nancy, Yapa, Roshini, Davis, J., Lallinger, Kathryn, Schmidt, Robyn, Kosinski, Andrzej, Al-Khatib, Sana, Sanders, Gillian·2018·Thrombosis and Haemostasis

DOI 10.1055/s-0038-1675400PMC PMC6754740

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Abstract

Background Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke. Medical therapy for decreasing stroke risk involves anticoagulation, which may increase bleeding risk for certain patients. In determining the optimal therapy for stroke prevention for patients with AF, clinicians use tools with various clinical, imaging and patient characteristics to weigh stroke risk against therapy-associated bleeding risk. Aim This article reviews published literature and summarizes available risk stratification tools for stroke and bleeding prediction in patients with AF. Methods We searched for English-language studies in PubMed, Embase and the Cochrane Database of Systematic Reviews published between 1 January 2000 and 14 February 2018. Two reviewers screened citations for studies that examined tools for predicting thromboembolic and bleeding risks in patients with AF. Data regarding study design, patient characteristics, interventions, outcomes, quality, and applicability were extracted. Results Sixty-one studies were relevant to predicting thromboembolic risk and 38 to predicting bleeding risk. Data suggest that CHADS2, CHA2DS2-VASc and the age, biomarkers, and clinical history (ABC) risk scores have the best evidence for predicting thromboembolic risk (moderate strength of evidence for limited prediction ability of each score) and that HAS-BLED has the best evidence for predicting bleeding risk (moderate strength of evidence). Limitations Studies were heterogeneous in methodology and populations of interest, setting, interventions and outcomes analysed. Conclusion CHADS2, CHA2DS2-VASc and ABC scores have the best prediction for stroke events, and HAS-BLED provides the best prediction for bleeding risk. Future studies should define the role of imaging tools and biomarkers in enhancing the accuracy of risk prediction tools. Primary Funding Source Patient-Centered Outcomes Research Institute (PROSPERO #CRD42017069999)

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Atrial Fibrillation Significantly Increases Total Mortality and Stroke Risk Beyond that Conveyed by the CHADS2 Risk Factors
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Cardiovascular Biomarker Score and Clinical Outcomes in Patients With Atrial Fibrillation
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Can Patients at Elevated Risk of Stroke Treated With Anticoagulants Be Further Risk Stratified?
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The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants
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Accumulation of Risk Factors Increases Risk of Thromboembolic Events in Patients With Nonvalvular Atrial Fibrillation
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Should Atrial Fibrillation Patients With Only 1 Nongender-Related CHA 2 DS 2 -VASc Risk Factor Be Anticoagulated?
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Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Impact of Time in Therapeutic Range on Contemporary Bleeding Risk Scores
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Long‐Term Stroke Risk Prediction in Patients With Atrial Fibrillation: Comparison of the ABC‐Stroke and CHA 2 DS 2 ‐VASc Scores
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Oral anticoagulation, stroke and thromboembolism in patients with atrial fibrillation and valve bioprosthesis
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Warfarin Initiation, Atrial Fibrillation, and Kidney Function: Comparative Effectiveness and Safety of Warfarin in Older Adults With Newly Diagnosed Atrial Fibrillation
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Continued Use of Warfarin in Veterans with Atrial Fibrillation After Dementia Diagnosis
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Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)
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Revisiting sex differences in outcomes in non-valvular atrial fibrillation: a population-based cohort study
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The Predictive Ability of the CHADS2 and CHA2DS2-VASc Scores for Bleeding Risk in Atrial Fibrillation: The MAQI2 Experience
Barnes, G. D., Gu, X., Haymart, B., Kline-Rogers, E. M., ALMANY, S. L., Kozłowski, J., Besley, D., Krol, G. D., Froehlich, J. B., & Kaatz, S. (2014) · Thrombosis Research · doi:10.1016/j.thromres.2014.05.034 · Cited by 36
Are Existing Risk Scores for Nonvalvular Atrial Fibrillation Useful for Prediction or Risk Adjustment in Patients With Chronic Kidney Disease?
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A Propensity Score Matched Comparison of Clinical Outcomes in Atrial Fibrillation Patients Taking Vitamin K Antagonists: Comparing the “Real-World” vs Clinical Trials
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The CHADS Score Role in Managing Anticoagulation After Surgical Ablation for Atrial Fibrillation
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Electronic Alert System for Improving Stroke Prevention Among Hospitalized Oral‐Anticoagulation‐Naïve Patients With Atrial Fibrillation: A Randomized Trial
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[11]Agency for Healthcare Research and Quality. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality Available at: https://www.effectivehealthcare.ahrq.gov/topics/cer-methods-guide/overview. Accessed November 27, 2017. 21433403

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Brundel, B. J. J. M., Ai, X., Hills, M. T., Kuipers, M. F., Lip, G. Y. H., & de Groot, N. M. S. (2022) · Nature Reviews Disease Primers · doi:10.1038/s41572-022-00347-9 · Cited by 545
2021 Focused Update Consensus Guidelines of the Asia Pacific Heart Rhythm Society on Stroke Prevention in Atrial Fibrillation: Executive Summary
Chao, T., Joung, B., Takahashi, Y., Lim, T. W., Choi, E., Chan, Y., Guo, Y., Sriratanasathavorn, C., Oh, S., Okumura, K., et al. (2021) · Thrombosis and Haemostasis · doi:10.1055/s-0041-1739411 · Cited by 476

See all 229

Authors: Borre, E., Goode, A., Raitz, G., Shah, B., Lowenstern, A., Chatterjee, R., Sharan, L., Allen LaPointe, N., Yapa, R., Davis, J., Lallinger, K., Schmidt, R., Kosinski, A., Al-Khatib, S., & Sanders, G.
Affiliations: Duke University (US)
Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States
University of Colorado Anschutz (US)
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States
Corresponding author: Sanders, Gillian
ORCID: Borre, Ethan
Goode, Adam
Shah, Bimal
Lowenstern, Angela
Chatterjee, Ranee
Kosinski, Andrzej
Sanders, Gillian
Venue: Thrombosis and Haemostasis
Publisher: Georg Thieme Verlag KG
Published: 2018-10-30
Volume: 118
Issue: 12
Pages: 2171-2187
ISSN: 0340-6245 (ISSN-L)
2567-689X
DOI: 10.1055/s-0038-1675400
PMC: PMC6754740
OpenAlex: W2899484044
Cited by: 229
References: 145
Citations by year: 2026: 11 · 2025: 17 · 2024: 30 · 2023: 26 · 2022: 31 · 2021: 44 · 2020: 38 · 2019: 26 · 2018: 4
FWCI: 5.20
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Thrombosis and Haemostasis (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Health and Human Services
Patient-Centered Outcomes Research Institute
National Institutes of Health (5t32hl069749-20)
Agency for Healthcare Research and Quality
National Heart, Lung, and Blood Institute (T32-HL069749)
National Institute of General Medical Sciences (T32GM007171)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords: non-valvular atrial fibrillation, stroke risk prediction, bleeding risk prediction, thromboembolic risk, risk stratification tools, HAS-BLED score, VASc score, anticoagulation, stroke prevention
MeSH terms: Atrial Fibrillation, Blood Coagulation, Hemorrhage, Humans, Risk, Thromboembolism, United States, Stroke

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Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review

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